Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VX0201X | Gynecologic Oncologist | 23255 | TN |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 23255 | TN |
NPI | 1033622725 |
---|---|
Provider Name | Courtney Roth |
First Address | Knoxville, TN 37931-4202 |
Second Address | Knoxville, TN 37920-1552 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2017 |
Last Update Date | 16/11/2017 |